Healthcare Provider Details

I. General information

NPI: 1346576733
Provider Name (Legal Business Name): REBECCA ELIZABETH ROTHENBURGER M.S., CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 EASTERN PKWY
LOUISVILLE KY
40217-1566
US

IV. Provider business mailing address

982 EASTERN PKWY
LOUISVILLE KY
40217-1566
US

V. Phone/Fax

Practice location:
  • Phone: 502-635-6397
  • Fax:
Mailing address:
  • Phone: 502-635-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09-094
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: